Evidence lacking on effectiveness of National Early Warning Scores

A review has found that while the National Early Warning Score (NEWS and its update NEWS2) is widely used across the NHS and globally, there is a surprising lack of high-quality evidence to prove it directly improves patient outcomes. The review was led by researchers at the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West).

NEWS is a “track-and-trigger” system used to detect clinical deterioration in patients by monitoring vital signs like heart rate, blood pressure and oxygen levels. Although its ability to predict which patients are at higher risk is well-documented, this new study is the first to look at whether using it leads to better patient outcomes.

The research, published in the journal Systematic Reviews, screened over 2,800 papers. The team went on to analyse 20 studies from around the world. The findings offer a cautious but optimistic look at the impact of NEWS / NEWS2:

• Reduction in deaths: There is “low certainty” evidence that using NEWS/NEWS2 reduces deaths in hospital
• Faster recovery and fewer emergencies: The review suggested NEWS/NEWS2 potentially reduced the length of hospital stays, cardiac arrests and intensive care (ICU) admissions
• Lack of large scale, high-quality studies: Despite being mandated by NHS England for acute hospitals and ambulance services, the review highlights a significant lack of large-scale, high-quality studies
• No harm found: None of the studies reviewed reported any negative clinical impacts from using the scoring system

Lauren Scott, Senior Research Associate at NIHR ARC West and lead author of the study, said:

“Our systematic review reveals a lack of large-scale, high-quality studies exploring the effectiveness of NEWS and NEWS2. As a widely used clinical tool, this is surprising.

“It also highlights a vital message: measurement is not the same as management. While NEWS helps identify sick patients, this does not necessarily result in improving patient outcomes, emphasising that measurement alone is not enough.”

This paper is the first comprehensive synthesis of evidence on this topic since NEWS was created in 2012. The authors call for more rigorous, large-scale studies to confirm exactly how these scoring systems can be optimised to ensure the best possible care for patients.